Sunday, July 12, 2015

What a coming-back shift

Dealing with patient's is one thing, dealing with family members is another!

Today was my first day back from having 2+ wks off - having vacation and dealing with a nasty head cold to finally feeling well enough to take care of patients and boy was it a shift.

TWO hours in and my pt was crazily delerious and thinking that birds were in the hospital and we just HAD to "deal with the birds", "the birds, the birds, they're everywhere" - which if I were him, I would be QUITE agitated. So I get it - BUT, when the daughter gets involved and become agitated that I am not doing something to "make him better" - Lady, I've only been with him for TWO hours - I know VERY little about him - just what I got from report and from his history.

So there I am trying to calm both pt AND daughter down - bloody hell, how did this happen to me?!

So off I go to call the MRP to ask for resperidone to manage the hallucinations - nope - he says that he gave orders earlier in the day to the nurse for seroquel and haldol and for me to give this.... ok so off I go to find these "orders" that I knew little about because the day nurse hadn't updated me on these - instead leaving me in the dark!

K so I pull the meds from my pyxis - and fail miserably attempt to give these oral meds - but by this point the pt is so agitated that he is suspicious of what I'm offering.... I attempt several times with different ways to get him to take with no results - dinner comes - and he won't touch it.

That was the last straw for the daughter - she starts cussing at me saying that no one is doing anything to help her father and that he just keeps going down hill. I try to calm her down but that does nothing and starts raising her voice - that's it - straw breaks the camel's back and I inform her that if she doesn't calm the f*ck down that I would notify security (whom is already in the room with another pt) to have her excorted out of the hospital if she can't be respectful. This doesn't deter her and she continues on about how she wants an umbudsman - I inform her that I can get the number if that's what she wants - she confirms this so off I go. I also give the go ahead to the security in the room to notify main security to send someone for back up - and I go get the # as well as notify the MRP about this situation. So by the time I go back to the room the security shows up and informs her that she's a visitor and that if she can't be respectful then she can be escorted out of the hospital. She becomes quite upset and is incredulous about the fact that I gave the go-ahead for security to come.

MRP was irritated that he needed to come speak to this daughter (he said he already spent an hour earlier in the day speaking to her about everything so couldn't understand why she was freaking out now) - and once he showed up she was COMPLETELY calm - and for some reason the pt completly relaxed with him around - enough so that I could get the haldol on board and he talked to the daughter while we were waiting for the haldol to kick in - once that starts to take hold, he allows the doctor to give him the seroquel and clonazepam but won't let me do anything. ERG!!! Well at least he took them! Two hours later he's FINALLY asleep in his bed - may he remain that way the rest of my shift!

Then while all this is happening I have another pt who had IV fluids and IV antibiotics ordered and hasn't had an IV access since nights and the day shift nurse is a tard and ALWAYS leaves stuff (especially the more difficult and time intensive things) for the next nurse - not ONCE did she inform the MRP that there was no IV access!!! Instead she tried to get it, then had a NEW nurse attempt (who is notorious for sucking at IV initiation!) but not ONCE did she contact ICU who have support nurses who attempt difficult IV starts or ICU stepdown to see if they could start it. ARGGGG. So now this responsibility is mine - so I attempt - I could find it but once you start it blows or won't thread.... ARG!!!! So off I go and call ICU (like you should!) as the one senior nurse on our unit who is good at IV initiation said she was "too busy" to try.... so I had to wait for ICU to come.... which they did about an hour after calling - and they get it in the AC but kink the catheter so it's difficult to use.... soooooo I was only able to get the IV antibiotic in and then it went interstitial. So by this point it's after 1930 - which means new nurses!!! So I called ICU and asked that once report is given could they send someone for this guy..... so about another hour goes by and someone comes and attempts 3 times with them blowing each time.... ARGGGG!!!! OK, I'm done..... so by this point this poor pt has been poked NINE times!!! I assessed his feet and they actually look like they're possible - but it requires a physician's order to do. BUT of course SOMETHING gets in the way.... a code blue on the unit next door so off goes the doc to deal with that!

By the time he gets back to our unit it's 2245hrs!!!! I tell him the situation - either a foot IV initiation so that he could get IV fluids, antibiotics and hydrocortisone (steroids) - OR give me an order for these things to be oral.... thankfully this pt was drinking and eating well so while the IV fluids would be helpful it's not URGENT or emergent for IV fluids to be required. Also, the pt wasn't septic so oral antibiotics should be alright til they figure out the IV situation - this pt TOTALLY needs a PICC line!!!! Perhaps I'll tell the MRP to order one for this pt!

Then you have 3 other pt's with required needs, as well as another pt who had diarrhea who required bedpanning four times in my shift as well as a blood product and several nebulizers. Ugh it's just too much for one person and there's no one that I could delegate to :(  Hopefully my next shifts are better!!!

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